Ethics in Health Care

1. Ethics in Health Care

2. Introduction • Ethics allows a health care worker to analyze information and make decisions based on what is right and good conduct • Modern health care has created many ethical dilemmas for the health care worker • This lesson will explore ethics, patients’ rights, advance directives and professional standards for the health care worker Ethics in Health Care

3. Objectives • Define ethics • List basic rules of ethics for the health care worker • Discuss and debate varying ethical dilemmas which have resulted from modern medicine • List the rights of patients who are receiving health care • Review long-term care Bill of Rights • Define advance directives Ethics in Health Care

4. Objectives (continued) • List the types of advanced directives and describe the role of the health care worker as it relates to advanced directives • Discuss the terms of the Patient Self-Determination Act (PSDA) • Explain how professional standards meet legal and ethical requirements in health care • Discuss importance of malpractice insurance and compare costs for varying health care professions Ethics in Health Care

5. Ethics • Ethics are a set of principles dealing with what is morally right or wrong • Each profession has their own code of ethics developed by their national organizations • Most contain the same basic principles however they may differ slightly Ethics in Health Care

6. Activity • Have students research the code of ethics for the profession which they have an interest in pursuing • Allow them to compare the code of ethics for the varying health care professions • Compare/contrast Ethics in Health Care

7. Ethical Dilemmas • Modern health care technology has created many ethical dilemmas • Assisted suicide – is it justified in certain patients? • Stem cell research- should aborted fetuses be used? • Should a patient be permitted to smoke marijuana if it eases effects of chemotherapy? Ethics in Health Care

8. Assignment • Present prompt for writing folder entry (prompt and rubric attached) • Researching an ethical dilemma • Set deadline for rough draft submission • For homework, have student do basic research either on their writing topic or other topic of interest which would pose an ethical dilemma • Be ready to present and debate their stand on that particular topic the next class meeting Ethics in Health Care

9. Basic Rules of Ethics • Put saving of life and promotion of health above all else • Make every effort to keep patient as comfortable as possible and to preserve life when possible • Respect patient’s choice to die peacefully and with dignity (advanced directive) • Treat all patients equally (avoid bias, prejudice, and discrimination) Ethics in Health Care

10. Rules of Ethics (cont) • Provide care for all persons to the best of your ability • Maintain competent level of skill consistent with occupation • Maintain confidentiality • Gossiping about patients is ethically wrong • Avoid immoral, unethical, or illegal practice Ethics in Health Care

11. Rules of Ethics (cont) • Show loyalty to patients, co-workers, and employer • Be sincere, honest and caring Ethics in Health Care

12. Patients’ Bill of Rights • Most of us have seen the sign in retail stores “The Customer is Always Right” • Patient and customer satisfaction is essential to health care facilities just as pleasing the customer is for retail stores Ethics in Health Care

13. Patients’ Rights • Patients’ rights are factors of care that patients can expect to receive • Health care facilities have written policies concerning patients' rights • All health care workers must honor these Ethics in Health Care

14. Activity • Obtain copy of specific clinical facility’s Patient Bill of Rights • Discuss and compare to AHA affirmed Bill of Rights Ethics in Health Care

15. “Patients’ Bill of Rights” • According to the American Hospital Association, the patient has right to: • Considerate and respectful care • Obtain complete current information concerning diagnosis, treatment, and prognosis • Receive information necessary to give informed consent • Have advance directive and/or refuse treament to extent permitted under law Ethics in Health Care

16. Rights (continued) • Privacy concerning medical care • Confidential treatment of all communications and records • Reasonable response to request for services • Obtain information regarding any relationship of the hospital to other health care and educational institutions Ethics in Health Care

17. Rights (cont) • Be advised of and have the right to refuse to participate in any research project • Expect reasonable continuity of care • Review medical records and examine bill with all charges explained • Be informed of any hospital rules or regulations Ethics in Health Care

18. Long-Term Care Bill of Rights • Residents of long-term care facilities are guaranteed rights under the Omnibus Budget Reconciliation Act (OBRA), established in 1987 Ethics in Health Care

19. “Residents’ Bill of Rights” • Free choice regarding physician, treatment, care, and participation in research • Freedom from abuse and chemical or physical restraints • Privacy and confidentiality of personal and clinical records • Accommodation of needs and choice regarding activities, schedules, and health care Ethics in Health Care

20. Residents’ Bill of Rights (cont) • Voice grievances without fear of retaliation or discrimination • Organize and participate in family/resident groups and in social, religious & community activities • Information on medical benefits, medical records, survey results and deficiencies of the facility, and advocacy groups who check on resident care and violation of rights Ethics in Health Care

21. Residents’ Bill of Rights (cont) • Manage personal funds and use personal possessions • Unlimited access to immediate family or relatives and to share a room with spouse if both are residents • Remain in the facility and not be transferred or discharged except for medical reasons, the welfare of resident or others, failure to pay, or if facility unable to meet resident’s needs, or ceases to operate Ethics in Health Care

22. Advance Directives • A patient’s instructions, usually relating to end-of-life issues regarding what medical treatment they want or do not want if they are unable to express their wishes • Advance directives are legally binding documents • http://www.youtube.com/watch?v=wlL4H8ecuAM Ethics in Health Care

23. http://www.youtube.com/watch?v=VWL6t7-6VHA • Alice’s Story and the need for Advance Directives Ethics in Health Care

24. Two Main Types • Durable Power of Attorney (POA) for health care • Living wills (obtain copy of one if possible or use samples in book, page 82) Ethics in Health Care

25. Advance Directives • Must be signed when the individual is competent and witnessed by two adults who will not benefit from the death Ethics in Health Care

26. Living Will • Document allowing individuals to state what measures should or should not be used to prolong life if their condition is terminal • Ex: CPR, ventilator, feeding tube, etc. • Frequently results in a “do not resuscitate” (DNR) order Ethics in Health Care

27. Durable Power of Attorney(POA) • Document permitting an individual (principal) to appoint another person (agent) to make any decisions regarding health care if the principal is unable to make those decisions • Usually give POA’s to spouses or adult children • May be given to any qualified adult however • Must be signed by principal, agent, and two adult witnesses Ethics in Health Care

28. Patient Self-Determination Act (PDSA) • Federal law that went into effect in 1990 • Require all health care facilities comply with the following requirements: • Inform every adult, both orally and in writing, of their right under state law to make decisions concerning medical care, including right to refuse treatment and right-to-die options Ethics in Health Care

29. PDSA (continued) • Provide information and assistance in preparing advance directives • Document any advance directives on patient’s record • Have written statements to implement the patient’s rights in the decision making process • Affirm there will be no discrimination or affect on care due to advance directive • Educate the staff on the medical and legal issues Ethics in Health Care

30. Advance Directives • Health care workers must be aware of and honor advance directives regardless of their beliefs • Patients will be asked if they have one upon admission to a health care facility Ethics in Health Care

31. Activity • View advance directive video by Medcom Trainex • Have students respond to the following scenario: • A patient has asked you about advance directives. What information can you offer? Explain what one is, in your own words as if you were speaking to a patient Ethics in Health Care

32. Assignment • One of the purpose of educating the public about advance directives is to encourage them to write it well in advance of the onset of terminal illness. Have students write their own advance directive instructing their loved ones as to their wishes as they near the end of life. • What would you include? • Would you want to live only on artificial respiration and artificial feeding? • This is a highly personal exercise and may be difficult for some. Be sensitive to their feelings and concerns. Ethics in Health Care

33. Professional Standards • Professional standards help meet legal responsibilities, ethics and patients’ rights • By following certain standards at all times, the health care worker can protect themselves, their employer and the patient • Some of the basic standards are as follows: Ethics in Health Care

34. Professional Standards • Perform only those procedures for which you have been trained and are legally permitted to do (scope of practice) • If asked to perform procedure for which you are not qualified, refuse • Use approved, correct methods while performing any procedure • Procedure manual • Obtain correct authorization before performing any procedure Ethics in Health Care

35. Professional Standards (cont) • Identify patient and obtain consent before performing any procedure • Check wrist band if available • State patient’s name clearly and repeat if necessary • Ask patient their name and birth date • If patient refuses do not perform procedure • Obtain written consent where needed Ethics in Health Care

36. Professional Standards (cont) • Observe all safety precautions • Keep all information confidential • Think before you speak and watch everything you say • Treat all patients equally • Accept no tips or bribes for care • If error occurs or you make a mistake, report it immediately to your supervisor Ethics in Health Care

37. Professional Standards (cont) • Behave professionally in dress, language, manners and actions • Liability • Errors can occur even with adhering to standards • liability insurance is a form of protection • Agencies offer policies at reasonable cost to health occupations workers and students • Clinical students in this program maintain liability insurance Ethics in Health Care

38. Activity • Have student choose one standard of care and develop consequences which could occur if this standard is violated • Have students use search engines to research sites to compare malpractice costs in the varying health care professions as well as state to state for physicians Ethics in Health Care

39. Summary • Always remember, it is your responsibility to understand the legal and ethical implications of your particular health career • Never hesitate to ask questions or request written policies from your employer • By following the basic standards, you will protect yourself, your employer, and the patient for whom you care for Ethics in Health Care